tbuckley/cabot-search huggingface dataset:
Abstract 12591: Atrial Fibrillation Detection (Incidence And Accuracy) By Implantable Loop Recorders For The Indications: Cryptogenic Stroke, Syncope, Or Palpitations: A Real World Cohort Study
Authors: Brent Klinkhammer, Noha Gayed, Sameer Jamal, Taya V Glotzer
Journal: Circulation (2022)

Introduction: Cryptogenic Stroke (CS), syncope, and palpitations are common indications for implantable loop recorder (ILR) insertion, however the incidence of new-onset atrial fibrillation (AF) in these groups in a real world clinical setting is not well characterized. Methods: At a single US center, we evaluated 273 consecutive patients who had a Medtronic Reveal LINQ™ LNQ11 implanted for the indications of CS, syncope, or palpitations from 2016-2021. All patients were followed remotely by Carelink. Patients with known AF were excluded. For each patient with an AF episode ≥ 2 minutes, the longest AF electrogram was adjudicated by an electrophysiologist and a cardiology fellow to confirm or refute the AF diagnosis. Results: Mean follow-up time was 21 months. There was no difference in mean age between the 3 groups. True, adjudicated AF was diagnosed more often in patients with palpitations and syncope than in patients with CS (table) [p &lt; 0.001]. The ILR reported AF in 92 patients (all groups), of which only 56 (61%) were adjudicated to be true AF. Of the 20 patients with a longest detected AF episode &lt;6 minutes, only 5 (25%) were true AF . Of the 72 patients with a longest detected AF of ≥ 6 minutes, 51 (71%) were true AF (p &lt; 0.001). Conclusions: True, adjudicated AF ≥ 6 minutes was detected in 11% of patients with CS, consistent with prior studies. However, in this real world cohort study, AF ≥ 6 minutes was more likely to be detected in patients with palpitations, followed by patients with syncope. The accuracy of ILR detected AF was significantly improved when the AF episode was ≥ 6 minutes duration.
Abstract 12623: Association Between Past and Present Operative Mortality in Congenital Heart Surgery
Authors: Sara K Pasquali, Sean M O'Brien, David M Shahian, Jennifer Romano, Jeffrey P Jacobs, John E Mayer
Journal: Circulation (2022)

Introduction: Operative mortality following congenital heart surgery is a foundational metric used across a variety of benchmarking, quality improvement, and public reporting initiatives. All of these efforts rely on mortality estimates reported from prior years, and it is unclear how well these reflect current outcomes. Methods: Adjusted operative mortality among Society of Thoracic Surgeons Congenital Heart Surgery Database index operations (2014-2019) was analyzed using standard risk-models. The association of mortality in “past” 4- and 1-year time intervals vs. the most recent year in the dataset (“present”) was evaluated using Bayesian hierarchical logistic regression. Estimates and 95% credible intervals (CrI) are presented. Results: Among 115,699 operations (106 hospitals) present observed mortality ranged from 2.3%-3.1% across quartiles, with regression to the mean evident more so vs. past 1-year than past 4-year data. Odds of present mortality were 2.04 (95%CrI 1.44-2.80) times higher for those in the past worst vs. best 4-year mortality quartile; no significant association was observed for the middle quartiles. The proportion of present hospital mortality variation explained by past mortality quartile was 52% (95%CrI 20%-90%) using past 4-year and 27% (95%CrI 2%-83%) using past 1-year data. Overall 66% of hospitals changed mortality quartiles from past to present (30% by 2 or more quartiles), with lower volume hospitals most impacted. Conclusions: Past mortality relates to present mortality primarily for groups of hospitals at the extremes, with past 4-year more informative than past 1-year data. However when considering individual hospitals, past may differ from present, regression to the mean is common, and many hospitals change quartiles. Past mortality estimates should be used thoughtfully and not as the sole factor informing present decision making.
Abstract 12549: What is the Efficacy of New Therapies in Black Patients With Heart Failure and a Reduced Ejection Fraction? A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Arjun K Pandey, Nitish K Dhingra, Avinash K Pandey, Pankaj Puar, Shamon Ahmed, Raj Verma, David Mazer, Javed Butler, Mitesh V Badiwala, Terrence Yau, bobby Yanagawa, Deepak L Bhatt, Subodh Verma
Journal: Circulation (2022)

Introduction: Evaluating the efficacy of newer medical therapies in black patients with heart failure with reduced ejection fraction (HFrEF) remains an important and unanswered question. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in HFrEF to compare outcomes in black versus non-black patients with a specific focus on new therapies, namely ARNIs and SGLT2 inhibitors. Methods: Medline, Embase and Cochrane CENTRAL were searched from inception until May 2022. Pairs of reviewers independently identified RCTs that 1) compared either an SGLT2 inhibitor or an ARNI to placebo/standard of care in HFrEF patients and 2) reported outcomes stratified by race. Outcomes were pooled using the Generic Inverse Variance or Mantel-Haenszel models, and risk of bias was assessed using the Cochrane tool. Results: Four RCTs (n=17,797; 6.6% black) were identified, all of which were published in the past decade. In the placebo/control arm, black patients had a higher rate of heart failure hospitalization or cardiovascular death compared to non-black/white patients (OR: 1.52, 95% CI: 1.26, 1.84; absolute difference: 81, [95% CI: 43, 124] more events per 1,000 patients). In two RCTs, there was a trend towards a greater reduction in the composite of cardiovascular death or heart failure hospitalization with SGLT2 inhibitors in black patients (n=483; RR: 0.61, 95% CI: 0.45, 0.83) compared to white patients (n=6,445; RR: 0.84, 95% CI: 0.75, 0.95; p-interaction=0.06). In two RCTs, treatment with an ARNI was associated with reductions in the composite of cardiovascular death or heart failure hospitalization in both black patients (n=744; HR: 0.67, 95% CI: 0.40, 1.11) and non-black/white patients (n=6,109; HR: 0.80, 95% CI: 0.72, 0.89; p-interaction= p=0.49). Conclusions: Black patients are poorly represented in contemporary heart failure trials, and have worse outcomes compared with non-black patients. Newer therapies such as ARNIs and SGLT2 inhibitors are efficacious in black patients. SGLT2 inhibitors may afford greater risk reduction in black compared to non-black patients.
Abstract 12483: Accurate QT Correction for Reliable Cardiac Risk Assessment
Authors: Esa Räsänen, Teemu Pukkila, Matias Kanniainen, Jiyeong Kim, Katriina Aalto-Setala, Ilya Potapov
Journal: Circulation (2022)

Introduction: In the electrocardiogram (ECG), the QT interval is one of the most important cardiac risk measures. For reliable interpretation, the QT interval must be corrected for the heart rate. Several approximative QT correction (QTc) models and methods have been developed. The most commonly used methods are the power-law formulas of Bazett and Fridericia, which are known to fail in various situations. It is generally accepted that no universally applicable QTc formulas can be constructed. Methods: We have developed a model-free QT correction method that minimizes the information transfer from the RR intervals (heart rate) to the QT intervals. This yields a reliable estimate for the true QTc. The resulting QTc values are compared to the conventional methods including Bazett, Fridericia, Hodges, and Framingham, and the individual QT correction. We use the ECG data of PhysioNet and the Telemetric and Holter ECG Warehouse (THEW). Results: Our method provides superior reliability and stability for QTc assessment. For healthy subjects in the PhysioNet database, the proportion of false positives for all the QTc intervals is only 3% with our method (Bazett: 16%; Fridericia: 10%). The pooled standard deviation is only 13 ms (Bazett: 32 ms; Fridericia: 28 ms; individual QTc: 24 ms). The figure shows a combined point cloud of RR and QT(c) intervals for the six longest recordings of the PhysioNet database. Conclusions: We find excellent potential in our QT correction to become the method of choice in QTc assessment. The method is applicable to all the ECG monitoring devices for clinical use, and it can be utilized in all the phases of drug development involving QT measurements.
Abstract 11952: Physician Preferences for Treatment of Low-Density Lipoprotein Cholesterol Among Patients With Atherosclerotic Cardiovascular Disease - A Discrete Choice Experiment
Authors: Marlon Graf, Suepattra G May, Sukyung Chung, Amit Khera, Laetitia A N'Dri, Joaquim Cristino, Batul Electricwala
Journal: Circulation (2022)

Introduction: Around 80% of patients with atherosclerotic cardiovascular disease (ASCVD) do not achieve adequate reduction of low-density lipoprotein cholesterol (LDL-C) in current clinical practice, especially among patients on statin monotherapy. Greater understanding of attributes favored by prescribing physicians may improve treatment outcomes. Methods: To understand attributes of putative statin ‘add-on’ LDL-C lowering therapies, we conducted a discrete choice experiment survey of 200 U.S. cardiologists and 50 primary care physicians (PCPs). The survey presented a series of discrete choices to respondents, systematically varied across 8 treatment attributes: % LDL-C reduction, myalgias, other side effects, route and frequency of administration, time to prior authorization, patient out-of-pocket cost (OOPC) and adherence. Data were analyzed using logistic regression with clustering and heterogeneity adjustments to estimate preference weights for each attribute. Results: Both cardiologists and PCPs most valued efficacy in LDL-C reduction, with odds ratio (OR) for treatment preference of 1.69 per additional 10% reduction in LDL-C, and minimization of monthly OOPC with OR of 0.90 per $10 increase. Cardiologists preferred injectable therapies, with 57.5% of respondents preferring a drug with attributes of a small interfering RNA (siRNA) injectable and 16.4% preferring attributes of a proprotein convertase subtilisin kexin type 9 inhibitor (PCSK9i) biologic over oral ezetimibe therapy, as compared to only 2.8% preference for siRNA injectable among PCPs vs. oral therapy. Across all respondents, preference for injectables was higher for patients with history of nonadherence, with 55.7% preferring a drug with health-care practitioner-based injection every 6 months and 25.4% preferring a drug with properties of monoclonal antibody-based home injections once or twice monthly. Conclusions: Results indicate LDL-C lowering efficacy is a primary driver of physician prescribing preferences, with PCPs placing increasing consideration on OOPC. For patients with suboptimal adherence - the majority of those seen in clinical practice - U.S. physicians are more likely to prefer less-frequent injectable to oral therapies.
Abstract 11590: Impact of Adverse Social and Behavioral Determinants of Health on In-Hospital Mortality Following an Acute Atherosclerotic Vascular Event at a Safety Net Community Hospital
Authors: Philippe F Nyembo, Holly Rodin, Gautam R Shroff
Journal: Circulation (2022)

Introduction: Safety net community hospitals (SNCH) care for patients with disproportionately high prevalence of adverse social and behavioral determinants of health (SBDH). We evaluated the impact of adverse SBDH on in-hospital mortality and 30-days readmission after a first atherosclerotic cardiovascular disease (ASCVD) event at a large urban SNCH. Methods: We performed a retrospective review of patients presenting with an ASCVD event (coronary heart disease, cerebrovascular disease, or peripheral artery disease) between 2015 and 2019. Adverse SBDH was defined as history of homelessness, mental illness, incarceration, or substance use disorder. We used logistic regression analysis to evaluate independent predictors of in-hospital mortality and 30-day readmission following ASCVD event. Results: A cohort of 1974 patients was identified, mean age 63.8 years with standard deviation (SD) of 14.5, patients with adverse SBDH were 8 years younger than those without any adverse SBDH (58.5 years,SD:12 vs. 66 years,SD:14.8; p&lt;0.0001). Atleast one adverse SBDH was noted in 28% of the cohort. Using multivariable analysis, presence of SBDH was not an independent predictor of in-hospital mortality or 30-day readmission following ASCVD event. Age above 65 years tripled the likelihood of in-hospital mortality. Black race and age above 45 years were independent predictors of 30-days readmission. Patients on aspirin and antihypertensives prior to admission were less likely to die in the hospital (Table 1). Conclusions: In this cohort from a SCNH with 28% prevalence of adverse SBDH, the presence of any adverse SBDH did not impact in-hospital mortality or 30-day readmission. However, notably, patients with adverse SBDH presenting with an index ASCVD event were about a decade younger than those without adverse SBDH.
Abstract 12534: Comparative Performance of Distinct Frailty Measures Among Patients Undergoing Percutaneous Left Atrial Appendage Closure
Authors: Allen Wang, Enrico G Ferro, Jiaman Xu, Yang Song, Tianyu Sun, Robert W Yeh, Dae H Kim, Jordan B Strom, Darae Ko, Daniel B Kramer
Journal: Circulation (2022)

Introduction: Frailty is associated with increased morbidity and mortality in patients undergoing left atrial appendage closure (LAAC). We compared the performance of two claims-based frailty measures in predicting adverse outcomes following LAAC. Methods: We identified patients 65 years and older who underwent LAAC between October 1, 2016 and December 31, 2019 in Medicare fee-for-service claims. Frailty was assessed using the previously validated Hospital Frailty Risk Score (HFRS) and Kim Claims-based Frailty Index (CFI). Patients were identified as frail based on HFRS ≥5 and CFI ≥0.25. Results: Of the 21,787 patients who underwent LAAC, frailty was identified in 45.6% by HFRS and 15.4% by CFI. There was modest agreement between the two frailty measures (kappa 0.25, Pearson’s correlation 0.62). After adjusting for age, sex, and comorbidities, frailty was associated with higher risk of 30-day mortality, 1-year mortality, 30-day readmission, long hospital stay, and short time at home (p&lt;0.01 for all) regardless of the frailty instrument used. Model discrimination was similar between the HFRS and the CFI with fair discrimination of all outcomes (C-statistic 0.686 - 0.759). The addition of frailty to standard comorbidities significantly improved model performance to predict 1-year mortality, long hospital stay, and short time at home (Delong p-value &lt;0.001). Conclusions: Despite significant variation in frailty detection and only modest agreement between the two frailty measures, frailty status was highly predictive of mortality, readmission, long hospital stay, and days at home. Future studies should focus on prospective evaluation of frailty in patients eligible for LAAC, which may further refine the relationship between frailty and adverse outcomes, and help inform shared decision-making in this population.
Abstract 11930: Ascension Health System Experience With Extended Ambulatory Electrocardiographic Monitoring: Implementation of a Novel Integrated Approach to Better Characterize Disparities in Healthcare
Authors: Robert A Pickett, Jeffrey T Ellis, Evangelos Hytopoulos, Lori Crosson, Mohammed N Khan, Kristopher M Heinzman
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) is an established risk factor for stroke, hospitalization and mortality. Whether AF differs by race has not been well characterized in the real world setting due to inherent challenges in linking large datasets across multiple databases. Methods: Extended ambulatory electrocardiographic (AECG) monitoring with Zio XT allows for continuous recording of cardiac rhythm data for up to 14 days in indicated patients. A preliminary dataset from the Ascension Health System electronic health records (EHR) archive on patients prescribed the Zio XT patch was retrospectively analyzed. The study population consisted of 6,293 patients treated at 34 Ascension centers in 6 states between January 2020 and April 2022. Patient EHR data were linked to proprietary device-specific rhythm reports for analyses. Results: Among 6,293 patients in whom EHR data were matched to Zio XT findings, the median (IQR) age was 63 (47, 73) years, 3,816 (60.6%) were female, and 1,038 (16.5%) were non-Caucasian. Median device wear time was 7.2 (5.0, 13.9) days. AF was detected in 749 (11.9%) patients, including 326 (5.2%) with 100% AF. Median AF burden was 37.0% (3.4%, 100%). Older white males had the highest risk of AF events, whereas younger non-white females had the lowest risk (Figure 1). Non-white subgroups demonstrated greater freedom from AF compared to whites. Conclusions: In these preliminary findings, the use of Zio XT for extended AECG monitoring in the Ascension Health System is in predominantly older patients. Patients were racially and geographically diverse, and females were well represented. More than 10% of patients had AF detected during the monitoring period. Despite small sample sizes, differences in AF detection by subgroups demonstrate that a tailored approach to managing AF remains a critically important research question. Linkage of patient EHR data with device-specific outcomes can be a useful approach to address this important unmet need.
Abstract 11766: Impact of Increasing Stent Length on Long-Term Clinical Outcomes Undergoing Intracoronary Imaging-Guided Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents
Authors: Yuta Kurosawa, Takeshi Shimizu, Yuya Sakuma, Himika Ohara, Yuki Muto, Yu Sato, Takatoyo Kiko, Akihiko Sato, Tomofumi Misaka, Akiomi Yoshihisa, Kazuhiko Nakazato, Takafumi Ishida, Yasuchika Takeishi
Journal: Circulation (2022)

Background: While longer stent length of first-generation drug-eluting stents (DES) has been associated with stent-related adverse events, the association between stent length of new-generation DES and clinical outcomes remains controversial. Methods and Results: Consecutive 1403 patients including 2277 lesions who underwent intracoronary imaging-guided percutaneous coronary intervention with 2nd- and 3rd-generation DES were enrolled. Patients were divided into two groups according to total stent length (TSL), and followed up for major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction and target lesion revascularization (TLR) for patients. Lesions were divided into two groups according to TSL as well, and followed up for TLR and stent thrombosis. In the per patient analysis, long TSL group (TSL ≥ 32 mm, n = 703) had higher prevalence of diabetes (54.5% vs. 45.2%, P &amp;lt 0.001), anemia (48.4% vs. 43.0%, P = 0.042), peripheral artery disease (&amp;lt% vs. 10.6%, P = 0.003), multi-vessel disease (64.7% vs. 36.2%, P &amp;lt 0.001) and chronic total occlusion (9.5% vs 3.4%, P 0.001) than short TSL group (TSL &amp;lt 32 mm, n = 691). In the follow up period (mean of 1528 days), MACE and TLR were significantly higher in long TSL group than in short TSL group (P = 0.009 and P = 0.037, respectively). In the multivariate analysis after adjusting for confounding factors, the long TSL was an independent predictor of MACE and TLR (hazard ratio [HR] 1.59, P = 0.002 and HR 1.74, P = 0.047). In the per lesion analysis, Kaplan-Meier curve revealed that TLR was significantly higher in long TSL group (TSL ≥ 26 mm, n = 1160) than short TSL group (TSL &lt; 26mm, n = 1117) (P = 0.017), while stent thrombosis was comparable between the two groups. In the multivariate analysis, TLR was an independent predictor of TLR (HR 1.62, P = 0.029). Conclusion: Longer stent length of new-generation DES was associated with MACE and TLR, but not with stent thrombosis.
Abstract 12465: Surgical Outcomes of Patients With Endomyocardial Fibrosis Operated at the Heart Institute in Mozambique
Authors: Carol Nhavoto, Sheila Magaia Aissa, Tavares Madede, Orvalho Augusto, Sozinho Estefane, Joao Macave, Alda Menete, Beatriz Ferreira
Journal: Circulation (2022)

Introduction: Endomyocardial fibrosis (EMF) is a myocardiopathy that results from restriction of the ventricular filling caused by the presence of fibrous tissue in the endocardium. It is estimated that this disease affects approximately 12 millions of people worldwide and most of these people are in the Sub-Saharan Africa. Until today there is no consensus regarding the best therapeutic approach in these patients, but there are reports of encouraging results in patients treated surgically. Objective: To describe the results of surgical treatment of patients with EMF and the factors that influence it. Methodology: 86 patients with EMF were operated at Instituto do Coração (Heart Institute) in Mozambique, between 2002 and 2017. Results: Most of the patients were male (61.6%) with ages between 3 and 39 years (mean, 12 years). Forty-three per cent (43%) of the patients were coming from the province of Inhambane and 81.4% of them had biventricular disease. Sixty-two per cent (62%) of the patients were in functional classes III/IV of New York Heart Association (NYHA) . After the surgery, most of the operated patients (70.9%) had improvement in the NYHA functional class. The post-operatory mortality was 6.9% and mainly related to heart failure. The cumulative mortality after 12, 24 and 60 months was 5.7%, 7.7% e 23.5% respectively. The survival after 5 years was estimated around 76.5%. Conclusion: Apart from an elevated post-operatory and cumulative mortality, EMF surgery can significantly improve the patients’ functional class and survival, so it can be considered a valid alternative to patients with EMF who present in advanced stages of the disease (NYHA functional classes III and IV).